Ghiselli, J Bone Joint Surg Am 2004 - Adjacent Segment Degeneration in the Lumbar Spine

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Adjacent Segment Degeneration in the Lumbar Spine

Ghiselli, Dawson, et al.·J Bone Joint Surg Am·2004·773 citations·Retrospective cohort

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Background

A primary concern after posterior lumbar spine arthrodesis is the potential for adjacent segment degeneration cephalad or caudad to the fusion segment. There is controversy regarding the subsequent degeneration of adjacent segments, and we are aware of no long-term studies that have analyzed both cephalad and caudad degeneration following posterior arthrodesis. A retrospective investigation was performed to determine the rates of degeneration and survival of the motion segments adjacent to the site of a posterior lumbar fusion.

Methods

215 patients who had undergone posterior lumbar arthrodesis were included in this study.
The study group included 126 female patients and 89 male patients.
The average duration of follow-up was 6.7 years.
Radiographs were analyzed with regard to arthritic degeneration at the adjacent levels both preoperatively and at the time of the last follow-up visit.
Disc spaces were graded on a 4-point arthritic degeneration scale.
Correlation analysis was used to determine the contribution of independent variables to the rate of degeneration.
Survivorship analysis was performed to describe the degeneration of the adjacent motion segments.

Results

59 (27.4%) of the 215 patients had evidence of degeneration at the adjacent levels and elected to have an additional decompression (15 patients) or arthrodesis (44 patients).
Kaplan-Meier analysis predicted a disease-free survival rate of 83.5% (95% confidence interval, 77.5% to 89.5%) at 5 years and of 63.9% (95% confidence interval, 54.0% to 73.8%) at 10 years after the index operation.
Although there was a trend toward progression of the arthritic grade at the adjacent disc levels, there was no significant correlation, with the numbers available, between the preoperative arthritic grade and the need for additional surgery.

Conclusions

The rate of symptomatic degeneration at an adjacent segment warranting either decompression or arthrodesis was predicted to be 16.5% at 5 years and 36.1% at 10 years. There appeared to be no correlation with the length of fusion or the preoperative arthritic degeneration of the adjacent segment.

Copyright remains with the authors and publisher.

Adjacent Segment Degeneration in the Lumbar Spine.

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Adjacent Segment Degeneration in the Lumbar Spine

Ghiselli, Dawson, et al.·J Bone Joint Surg Am·2004·773 citations·Retrospective cohort

|

Background

A primary concern after posterior lumbar spine arthrodesis is the potential for adjacent segment degeneration cephalad or caudad to the fusion segment. There is controversy regarding the subsequent degeneration of adjacent segments, and we are aware of no long-term studies that have analyzed both cephalad and caudad degeneration following posterior arthrodesis. A retrospective investigation was performed to determine the rates of degeneration and survival of the motion segments adjacent to the site of a posterior lumbar fusion.

Methods

215 patients who had undergone posterior lumbar arthrodesis were included in this study.
The study group included 126 female patients and 89 male patients.
The average duration of follow-up was 6.7 years.
Radiographs were analyzed with regard to arthritic degeneration at the adjacent levels both preoperatively and at the time of the last follow-up visit.
Disc spaces were graded on a 4-point arthritic degeneration scale.
Correlation analysis was used to determine the contribution of independent variables to the rate of degeneration.
Survivorship analysis was performed to describe the degeneration of the adjacent motion segments.

Results

59 (27.4%) of the 215 patients had evidence of degeneration at the adjacent levels and elected to have an additional decompression (15 patients) or arthrodesis (44 patients).
Kaplan-Meier analysis predicted a disease-free survival rate of 83.5% (95% confidence interval, 77.5% to 89.5%) at 5 years and of 63.9% (95% confidence interval, 54.0% to 73.8%) at 10 years after the index operation.
Although there was a trend toward progression of the arthritic grade at the adjacent disc levels, there was no significant correlation, with the numbers available, between the preoperative arthritic grade and the need for additional surgery.

Conclusions

The rate of symptomatic degeneration at an adjacent segment warranting either decompression or arthrodesis was predicted to be 16.5% at 5 years and 36.1% at 10 years. There appeared to be no correlation with the length of fusion or the preoperative arthritic degeneration of the adjacent segment.

Copyright remains with the authors and publisher.

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